Deans' stroke musings: Factors Associated with Stroke Misdiagnosis in the Emergency Department: A Retrospective Case-Control Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, September 25, 2019

Factors Associated with Stroke Misdiagnosis in the Emergency Department: A Retrospective Case-Control Study

Another reason to switch to artificial intelligence to diagnose strokes. Maybe one of these much faster methods:

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes

The latest here:

Factors Associated with Stroke Misdiagnosis in the Emergency Department: A Retrospective Case-Control Study

Neuroepidemiology 2018;51:123–127

Abstract

Background: Failure to recognise acute stroke may result in worse outcomes due to missed opportunity for acute stroke therapies. Our study examines factors associated with stroke misdiagnosis in patients admitted to a large comprehensive stroke centre.
Methods: Retrospective review comparing 156 consecutive stroke patients misdiagnosed in emergency department (ED) with 156 randomly selected stroke controls matched for age, gender, language spoken and stroke subtype for the period 2014–2016.
Results: There were 141 ischemic and 15 hemorrhagic misdiagnosed strokes (median age: 77 years, male:female = 1.3: 1). Symptom resolution, altered mental status, nausea/vomiting, dizziness and vertigo favored misdiagnosis (p < 0.05). Hemiparesis and dysarthria favored an accurate diagnosis (p < 0.05). Misdiagnosed patients were more commonly triaged into a lower ED category (62 vs. 42%, p = 0.001), clinically assessed as Face, Arm, Speech and Time (FAST) – negative (78 vs. 22%, p < 0.001) and underwent delayed CT imaging (median 4.1 vs. 1.5 h, p < 0.001). Misdiagnosed patients were more likely to have posterior circulation stroke (PCS; 39 vs. 22%, p = 0.01) and be admitted under non-neurological services (35 vs. 11%, p < 0.001) with worse discharge outcomes including increased mortality.
Conclusions: Patients with stroke misdiagnosis were commonly FAST-negative with nonspecific symptoms including altered mental status, dizziness and nausea/vomiting often associated with PCS. Improved diagnostic accuracy may increase access to acute therapies.
© 2018 S. Karger AG, Basel

Venkat A.^a · Cappelen-Smith C.^a,b,c · Askar S.^a,b · Thomas P.R.^a,b · Bhaskar S.^a,b,c,d,e,f · Tam A.^a · McDougall A.J.^a,b,c · Hodgkinson S.J.^a,b,c · Cordato D.J.^a,b,c Author affiliations Keywords: StrokeMisdiagnosisEmergency department